from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
from io import BytesIO

# ── Colour palette ──────────────────────────────────────────────────────────
NAVY        = RGBColor(0x1A, 0x3A, 0x5C)   # deep navy - title bars
TEAL        = RGBColor(0x00, 0x7A, 0x87)   # teal accent
LIGHT_TEAL  = RGBColor(0xE0, 0xF4, 0xF6)  # very light teal - content bg
ORANGE      = RGBColor(0xE8, 0x7A, 0x1E)   # warm orange - highlights
WHITE       = RGBColor(0xFF, 0xFF, 0xFF)
DARK_GRAY   = RGBColor(0x2D, 0x2D, 0x2D)
MID_GRAY    = RGBColor(0x55, 0x55, 0x55)
LIGHT_GRAY  = RGBColor(0xF5, 0xF5, 0xF5)
GOLD        = RGBColor(0xF0, 0xC0, 0x40)

prs = Presentation()
prs.slide_width  = Inches(13.333)
prs.slide_height = Inches(7.5)
blank = prs.slide_layouts[6]

# ────────────────────────────────────────────────────────────────────────────
# Helper functions
# ────────────────────────────────────────────────────────────────────────────

def add_rect(slide, x, y, w, h, fill_color, alpha=None):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    shape.line.fill.background()
    return shape

def add_text(slide, text, x, y, w, h, font_size=18, bold=False, color=DARK_GRAY,
             align=PP_ALIGN.LEFT, wrap=True, italic=False, anchor=MSO_ANCHOR.TOP):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.vertical_anchor = anchor
    tf.margin_left = Pt(4)
    tf.margin_right = Pt(4)
    tf.margin_top = Pt(2)
    tf.margin_bottom = Pt(2)
    p = tf.paragraphs[0]
    p.alignment = align
    r = p.add_run()
    r.text = text
    r.font.size = Pt(font_size)
    r.font.bold = bold
    r.font.italic = italic
    r.font.color.rgb = color
    r.font.name = "Calibri"
    return tb

def add_bullet_slide(slide, title, bullets, subtitle=None,
                     header_color=NAVY, accent=TEAL, bg=LIGHT_TEAL,
                     col2_bullets=None):
    """Standard content slide: header bar + bullet content area."""
    # Background
    add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GRAY)
    # Top header bar
    add_rect(slide, 0, 0, 13.333, 1.2, header_color)
    # Accent bottom strip on header
    add_rect(slide, 0, 1.2, 13.333, 0.07, accent)
    # Title
    add_text(slide, title, 0.3, 0.1, 12.5, 1.0,
             font_size=28, bold=True, color=WHITE, align=PP_ALIGN.LEFT,
             anchor=MSO_ANCHOR.MIDDLE)
    if subtitle:
        add_text(slide, subtitle, 0.3, 0.75, 12.5, 0.5,
                 font_size=14, bold=False, color=GOLD, align=PP_ALIGN.LEFT)

    if col2_bullets:
        # Two-column layout
        col_w = 6.0
        for col_idx, blist in enumerate([bullets, col2_bullets]):
            cx = 0.3 + col_idx * 6.6
            # column bg
            add_rect(slide, cx - 0.05, 1.35, col_w + 0.15, 5.9, WHITE)
            tb = slide.shapes.add_textbox(Inches(cx), Inches(1.4), Inches(col_w), Inches(5.8))
            tf = tb.text_frame
            tf.word_wrap = True
            tf.margin_left = Pt(6)
            tf.margin_right = Pt(6)
            first = True
            for b in blist:
                if first:
                    p = tf.paragraphs[0]
                    first = False
                else:
                    p = tf.add_paragraph()
                p.space_before = Pt(4)
                p.space_after = Pt(2)
                if b.startswith("##"):
                    r = p.add_run()
                    r.text = b[2:].strip()
                    r.font.size = Pt(15)
                    r.font.bold = True
                    r.font.color.rgb = TEAL
                    r.font.name = "Calibri"
                elif b.startswith("--"):
                    p.level = 1
                    r = p.add_run()
                    r.text = "   " + b[2:].strip()
                    r.font.size = Pt(13)
                    r.font.color.rgb = MID_GRAY
                    r.font.name = "Calibri"
                else:
                    r = p.add_run()
                    r.text = "\u2022  " + b
                    r.font.size = Pt(14)
                    r.font.color.rgb = DARK_GRAY
                    r.font.name = "Calibri"
    else:
        # Single-column
        add_rect(slide, 0.3, 1.35, 12.7, 5.9, WHITE)
        tb = slide.shapes.add_textbox(Inches(0.45), Inches(1.45), Inches(12.3), Inches(5.75))
        tf = tb.text_frame
        tf.word_wrap = True
        tf.margin_left = Pt(6)
        tf.margin_right = Pt(6)
        first = True
        for b in bullets:
            if first:
                p = tf.paragraphs[0]
                first = False
            else:
                p = tf.add_paragraph()
            p.space_before = Pt(5)
            p.space_after = Pt(2)
            if b.startswith("##"):
                r = p.add_run()
                r.text = b[2:].strip()
                r.font.size = Pt(16)
                r.font.bold = True
                r.font.color.rgb = TEAL
                r.font.name = "Calibri"
            elif b.startswith("--"):
                p.level = 1
                r = p.add_run()
                r.text = "      \u25E6  " + b[2:].strip()
                r.font.size = Pt(13.5)
                r.font.color.rgb = MID_GRAY
                r.font.name = "Calibri"
            else:
                r = p.add_run()
                r.text = "\u2022  " + b
                r.font.size = Pt(14.5)
                r.font.color.rgb = DARK_GRAY
                r.font.name = "Calibri"

    # Bottom footer bar
    add_rect(slide, 0, 7.25, 13.333, 0.25, NAVY)
    add_text(slide, "Physiology of Nose & PNS  |  Postgraduate ENT", 0.2, 7.26, 10, 0.22,
             font_size=9, color=RGBColor(0xBB, 0xCC, 0xDD), align=PP_ALIGN.LEFT)


# ════════════════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE SLIDE
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
# Full background
add_rect(slide, 0, 0, 13.333, 7.5, NAVY)
# Diagonal accent panel
shape = slide.shapes.add_shape(1, Inches(8.5), Inches(0), Inches(4.833), Inches(7.5))
shape.fill.solid()
shape.fill.fore_color.rgb = TEAL
shape.line.fill.background()
# Thin gold line
add_rect(slide, 0, 5.0, 8.5, 0.06, GOLD)
# Title
add_text(slide, "PHYSIOLOGY OF NOSE\nAND PARANASAL SINUSES",
         0.5, 1.5, 8.0, 2.8, font_size=38, bold=True, color=WHITE,
         align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE)
# Subtitle
add_text(slide, "A Comprehensive Review for Postgraduates",
         0.5, 4.2, 8.0, 0.6, font_size=18, italic=True, color=GOLD,
         align=PP_ALIGN.LEFT)
add_text(slide, "Department of ENT & Head-Neck Surgery",
         0.5, 4.9, 8.0, 0.5, font_size=15, color=RGBColor(0xBB, 0xCC, 0xDD),
         align=PP_ALIGN.LEFT)
add_text(slide, "Source: Cummings Otolaryngology | Scott-Brown's ORL | Ganong's Physiology",
         0.5, 6.8, 8.0, 0.5, font_size=10, color=RGBColor(0x88, 0xAA, 0xCC),
         align=PP_ALIGN.LEFT)
# Right panel text
add_text(slide, "Topics Covered", 8.7, 0.4, 4.2, 0.6, font_size=18, bold=True,
         color=WHITE, align=PP_ALIGN.LEFT)
topics = [
    "Anatomy Overview",
    "Nasal Airflow & Resistance",
    "Nasal Valve",
    "Nasal Cycle",
    "Air Conditioning",
    "Mucociliary Clearance",
    "Olfaction",
    "Nasal Reflexes",
    "PNS - Functions",
    "Osteomeatal Complex",
    "Sinus Ventilation",
    "Clinical Correlates",
]
tb = slide.shapes.add_textbox(Inches(8.7), Inches(1.1), Inches(4.2), Inches(6.0))
tf = tb.text_frame
tf.word_wrap = True
tf.margin_left = Pt(4)
first = True
for t in topics:
    if first:
        p = tf.paragraphs[0]
        first = False
    else:
        p = tf.add_paragraph()
    p.space_before = Pt(5)
    r = p.add_run()
    r.text = "\u2714  " + t
    r.font.size = Pt(13.5)
    r.font.color.rgb = WHITE
    r.font.name = "Calibri"


# ════════════════════════════════════════════════════════════════════════════
# SLIDE 2 — OVERVIEW / OUTLINE
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Overview: Why Study Nasal Physiology?",
    bullets=[
        "The nose is far more than an air passage - it is a sophisticated physiological organ",
        "Performs filtration, humidification, warming, olfaction, and immune defence",
        "Paranasal sinuses (PNS) modulate airflow, reduce skull weight, and drain via OMC",
        "Understanding physiology underpins every rhinological surgical decision",
        "##Key Domains",
        "Aerodynamics: airflow, resistance, nasal valve",
        "Mucociliary transport: ciliary beat, mucus layers, clearance pathways",
        "Sensory: olfaction, nasal reflexes, air conditioning",
        "Sinus physiology: ventilation, pressure, drainage",
        "##Clinical Relevance",
        "Septal deviation, turbinate hypertrophy, chronic rhinosinusitis, anosmia",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 3 — ANATOMY OVERVIEW (quick)
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Surgical Anatomy: Quick Review",
    bullets=[
        "##External Nose",
        "Nasal bones + upper lateral cartilages (ULC) + lower lateral cartilages (LLC)",
        "Nasal valve angle: 10-15° between ULC and septum (critical for resistance)",
        "##Internal Nose",
        "Septum: perpendicular plate (ethmoid) + vomer + septal cartilage",
        "Turbinates: inferior (largest), middle, superior, supreme (inconstant)",
        "Inferior turbinate: erectile tissue, greatest mucosal surface",
        "##Key Spaces",
        "Sphenoethmoidal recess: drains sphenoid sinus",
        "Superior meatus: drains posterior ethmoid cells",
        "Middle meatus: drains maxillary, frontal, anterior ethmoid - OMC",
        "Inferior meatus: nasolacrimal duct opens here",
    ],
    col2_bullets=[
        "##Blood Supply",
        "Anterior ethmoidal a. (ophthalmic a.) - upper septum",
        "Posterior ethmoidal a. - upper septum",
        "Sphenopalatine a. (maxillary a.) - posterior septum, turbinates",
        "Greater palatine a. - anterior septum (Little's area)",
        "Little's area (Kiesselbach's plexus): confluence anteriorly - epistaxis site",
        "##Nerve Supply",
        "Olfactory (CN I): superior concha & roof",
        "Ophthalmic division (V1): anterior nasal septum",
        "Maxillary division (V2): lateral wall & floor",
        "Autonomic: sympathetic (vasoconstriction) & parasympathetic (vasodilation, secretion)",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 4 — NASAL AIRFLOW & VALVE
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Nasal Airflow Dynamics & Nasal Valve",
    bullets=[
        "##Airflow Pattern",
        "Air enters vestibule → narrows at nasal valve → disperses in cavity",
        "Velocity at nasal valve at rest: ~16 m/s (cadaver studies)",
        "Velocity decelerates 4-fold on entering main nasal cavity",
        "Deceleration promotes turbulence - essential for air conditioning and olfaction",
        "50% of inspired air passes along the nasal floor (physiological models)",
        "##Nasal Valve (narrowest point)",
        "Bounded by: caudal ULC, septum, head of inferior turbinate, nasal floor",
        "Angle 10-15° - smallest cross-sectional area of entire respiratory tract",
        "Resistance varies inversely and exponentially with cross-sectional area",
        "Decongestion alone reduces resistance by 1/3; alar retraction reduces by 2/3",
        "Venturi effect: dynamic collapse during forced inspiration (internal valve collapse)",
        "##Ohm's Formula (nasal resistance)",
        "Resistance = Pressure difference / Airflow (cm H2O / L/s)",
        "Normal combined nasal resistance: < 3 cm H2O/L/s",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 5 — NASAL RESISTANCE & REGULATION
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Regulation of Nasal Resistance",
    bullets=[
        "##Vascular Erectile Tissue",
        "Inferior & middle turbinates contain capacitance sinusoids (erectile tissue)",
        "Engorgement → mucosal thickening → increased resistance",
        "Decongestion → venous drainage → decreased resistance",
        "##Autonomic Control",
        "Parasympathetic: vasodilation of sinusoids + capillaries → congestion + secretion",
        "Sympathetic: steady vasoconstrictor tone (baseline patency)",
        "Hormonal: estrogens (OCP, pregnancy) → mucosal hypertrophy → obstruction",
        "Nasal obstruction can be felt without anatomic obstruction (neural perception)",
        "##Turbulent vs Laminar Flow",
        "Turbulent flow: perceived as low flow → sensation of stuffiness",
        "Causes: septal deviation, septal perforations",
        "##Measurement Tools",
        "Acoustic rhinometry: noninvasive, cross-sectional area mapping (static)",
        "Rhinomanometry (airflow rhinometry): dynamic - resistance before/after decongestant",
        "Saccharin clearance test: mucociliary transport time",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 6 — NASAL CYCLE
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "The Nasal Cycle",
    bullets=[
        "##Definition",
        "Alternating congestion and decongestion of the two nasal fossae",
        "Described first by Heetderks (1927) - observed in 80% of normal population",
        "Mean duration: ~2.5 hours per cycle",
        "##Mechanism",
        "Controlled by autonomic nervous system - hypothalamic regulation",
        "Turbinates in one fossa congest while the opposite decongest",
        "Total bilateral nasal resistance remains constant throughout cycle",
        "##Positional Effect",
        "Dependent nasal fossa fills when patient is in lateral decubitus position",
        "Postulated function: promotes turning during sleep (prevents pressure sores)",
        "##Clinical Implications",
        "Paradoxical nasal obstruction: patient feels obstruction on the OPEN side",
        "In septal deviation: fixed increased resistance + nasal cycle = variable complaint",
        "Turgescent phase of normal side perceived as obstruction on normal side",
        "Essential knowledge to avoid misinterpreting turbinate asymmetry",
        "##Clinical Pearl",
        "Never interpret unilateral turbinate enlargement without considering nasal cycle phase",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 7 — AIR CONDITIONING
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Air Conditioning: Humidification, Warming & Filtration",
    bullets=[
        "##Overview",
        "The nose conditions inspired air to ~37°C and ~100% relative humidity by the nasopharynx",
        "Three functions: warming, humidification, and particle filtration",
        "##Warming",
        "Nasal mucosal blood vessels form a countercurrent heat exchanger",
        "Inspired air warmed from ambient to near body temperature within nasal passages",
        "Turbinates increase surface area 5-fold for efficient heat exchange",
        "##Humidification",
        "Nasal mucosa produces ~1 litre of fluid/day",
        "Serous and mucous glands + transepithelial fluid transfer",
        "Dry air (desert, winter heating) impairs ciliary function",
        "##Particle Filtration",
        "Vibrissae in vestibule: filter large particles (>10 microns)",
        "Turbulent airflow + mucus layer: trap medium particles (2-10 microns)",
        "Mucociliary transport: removes trapped particles to nasopharynx",
        "Fine particles (<2 microns) reach lower airways (role of mucociliary barrier in sinuses)",
        "##Impairment",
        "Septal perforations, total rhinectomy, laryngectomy - lose conditioning function",
        "Atrophic rhinitis, dry environments, smoking disrupt humidification",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 8 — MUCOCILIARY CLEARANCE
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Mucociliary Clearance",
    bullets=[
        "##Mucus Blanket - Two-Layer System",
        "Periciliary layer (sol layer): aqueous, low viscosity - cilia move freely",
        "Gel layer (mucous blanket): viscous upper layer - traps particles",
        "Cilia tips have small hooks to engage viscous gel layer during propulsive stroke",
        "##Ciliary Ultrastructure",
        "9+2 axonemal structure: 9 outer doublet microtubules + 1 central pair",
        "Outer pairs linked by nexin bridges; connected to inner pair by radial spokes",
        "Inner & outer dynein arms: Mg2+-dependent ATPase - convert ATP to ADP",
        "Sliding of outer doublets generates ciliary motion",
        "##Ciliary Beat",
        "Beat frequency: 7-16 Hz at body temperature (32-40°C range: constant frequency)",
        "Propulsive (effective) stroke: cilium straightens, tip engages viscous layer",
        "Recovery (preparatory) stroke: cilium bends in aqueous layer (power-saving)",
        "Metachronous coordination: wave-like pattern propels mucus posteriorly",
        "##Clearance Pathway",
        "From anterior nose posteriorly - through middle meatus - around Eustachian orifice",
        "Sinus mucus joins lateral nasal wall mucus at middle meatus (OMC)",
        "Finally swallowed (not expectorated under normal conditions)",
    ],
    col2_bullets=[
        "##Factors Affecting Ciliary Function",
        "Optimal temperature: 32-40°C (stops below 10°C and above 45°C)",
        "Optimal pH: > 6.4, up to pH 8.5 (alkaline medium tolerated)",
        "Isotonic saline preserves function",
        "Hyperosmolar (>5% above) or hypoosmolar (>2% below) isotonic: ciliary paralysis",
        "Dry conditions: stop ciliary action",
        "Smoking: direct toxic damage, impairs beat, reduces frequency",
        "URTI: cilia damaged by viruses - contributes to secondary bacterial infection",
        "Potassium ions: affect only at non-physiological concentrations",
        "##Clinical Conditions",
        "Primary Ciliary Dyskinesia (PCD / Kartagener syndrome)",
        "-- Absent dynein arms → immotile cilia → mucus stasis",
        "-- Presents: recurrent sinusitis, bronchiectasis, otitis media",
        "-- Situs inversus in 50% (Kartagener triad)",
        "Cystic Fibrosis: abnormally thick mucus overwhelms normal cilia",
        "Chronic Rhinosinusitis: impaired mucociliary clearance → perpetuates infection",
        "##Tests",
        "Saccharin clearance test: saccharin placed on anterior inferior turbinate",
        "Normal: taste perceived in <30 min",
        "Electron microscopy of biopsy: diagnose PCD",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 9 — OLFACTION
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Olfaction: Physiology of Smell",
    bullets=[
        "##Olfactory Epithelium",
        "Located: superior conchae, nasal roof (cribriform plate region)",
        "Pseudostratified epithelium - thicker than respiratory epithelium",
        "Cell types: olfactory receptor cells, sustentacular (supporting) cells, basal cells",
        "Bowman's glands: serous secretion dissolves odorant molecules",
        "##Olfactory Receptor Neurons (ORN)",
        "Bipolar neurons with a single thin dendrite ending in a knob",
        "Olfactory cilia extend from the knob (6-8 per neuron) bearing G-protein-coupled receptors",
        "~400 functional olfactory receptor genes in humans",
        "One olfactory receptor type per neuron",
        "##Signal Transduction",
        "Odorant binds receptor → Gs protein → adenylyl cyclase → cAMP ↑",
        "cAMP opens cyclic nucleotide-gated (CNG) channels → Na+/Ca2+ influx",
        "Depolarization → action potential in CN I fibers",
        "##Neural Pathway",
        "ORN axons (CN I) → cribriform plate → olfactory bulb (glomeruli)",
        "Olfactory bulb → olfactory tract → primary olfactory cortex (piriform cortex)",
        "Connections to: amygdala, entorhinal cortex, orbitofrontal cortex, hypothalamus",
        "Only special sense NOT relayed through thalamus first (direct cortical access)",
        "##Regeneration",
        "ORNs are among the few neurons capable of regeneration (replaced by basal cells)",
        "Supporting cells release neurotrophic factors stimulating new ORN genesis",
    ],
    col2_bullets=[
        "##Types of Olfactory Loss",
        "Anosmia: complete loss of smell",
        "Hyposmia: diminished smell",
        "Hyperosmia: heightened sensitivity",
        "Dysosmia / Parosmia: distorted smell",
        "Phantosmia: smell without stimulus",
        "##Causes of Anosmia",
        "Conductive: nasal obstruction, polyps, CRS (blockage of odorant access)",
        "Sensorineural: URTI (post-viral), head injury, neurodegenerative (Alzheimer's)",
        "Post-viral: SARS-CoV-2 infects supporting cells → ORN damage",
        "-- Virus binds/depletes sustentacular cells",
        "-- ORNs not directly infected but suffer secondary damage",
        "Toxic/drug: methotrexate, intranasal cocaine",
        "Cribriform plate fracture: shearing of CN I filaments",
        "##Testing Olfaction",
        "Sniffin' Sticks: threshold, discrimination, identification (TDI score)",
        "UPSIT (University of Pennsylvania Smell Identification Test)",
        "Connecticut Chemosensory Clinical Research Center (CCCRC) test",
        "MRI: olfactory bulb volume (reduced in PD, Alzheimer's)",
        "##Clinical Pearl",
        "Olfactory dysfunction may be earliest sign of Parkinson's disease",
        "Post-COVID hyposmia: most cases recover within weeks-months",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 10 — NASAL REFLEXES & IMMUNE FUNCTION
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Nasal Reflexes & Immunological Functions",
    bullets=[
        "##Nasal Reflexes",
        "Nasobronchial reflex: nasal irritation → bronchoconstriction (nasonasal & nasopulmonary)",
        "Sneezing reflex: irritant → afferent V1/V2 → brainstem → efferent forced expiration",
        "Diving reflex: cold water on face → apnea, bradycardia, peripheral vasoconstriction",
        "Nasocardiac reflex: pressure on nasal mucosa → vagal bradycardia (anesthesia concern)",
        "##Immunological Role",
        "Nasal mucosa: first line of adaptive and innate immune defence",
        "IgA secreted into nasal mucus - neutralizes pathogens",
        "Nasal-associated lymphoid tissue (NALT): equivalent of Waldeyer's ring",
        "Mast cells, eosinophils, dendritic cells in lamina propria",
        "Nasal mucosa: site of allergic sensitization (IgE-mediated Type I hypersensitivity)",
        "##Nasal Nitric Oxide",
        "Paranasal sinuses are major source of nasal nitric oxide (NO)",
        "NO: bacteriostatic, antifungal, vasodilator",
        "Nasal NO used diagnostically: LOW in Primary Ciliary Dyskinesia",
        "##Nasal Secretions",
        "~1 L/day total produced; mostly reabsorbed or swallowed",
        "Lysozyme, lactoferrin, IgA, defensins in nasal secretions",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 11 — PARANASAL SINUSES: ANATOMY & OMC
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Paranasal Sinuses: Anatomy & Osteomeatal Complex",
    bullets=[
        "##Maxillary Sinus (largest)",
        "Volume: ~15 mL; floor = alveolar process; roof = orbital floor",
        "Ostium: medial wall - opens into middle meatus via ethmoid infundibulum",
        "Accessory ostia common; ostium positioned superiorly (poor gravity drainage)",
        "##Frontal Sinus",
        "Drains via nasofrontal duct → frontal recess → middle meatus",
        "Variable size; absent in 5%, may be unilateral; has inner table and outer table",
        "##Ethmoid Sinuses",
        "Anterior ethmoid (agger nasi, uncinate, ethmoid bulla): drain to middle meatus",
        "Posterior ethmoid: drains to superior meatus",
        "Paper-thin lamina papyracea separates ethmoid from orbit",
        "##Sphenoid Sinus",
        "Drains via sphenoethmoidal recess → posterior nasal cavity",
        "Surrounded by: optic nerve, ICA, pituitary, CN III-VI (clinically significant)",
        "##Osteomeatal Complex (OMC)",
        "Functional unit draining frontal, anterior ethmoid, maxillary sinuses",
        "Components: uncinate process, ethmoid infundibulum, hiatus semilunaris, ethmoid bulla",
        "Blockage of OMC: central event in chronic rhinosinusitis",
        "FESS targets OMC to restore drainage and ventilation",
    ],
    col2_bullets=[
        "##Development of PNS",
        "Maxillary: present at birth, reaches adult size by 18-20 years",
        "Ethmoid: present at birth (air cells visible on X-ray by age 2)",
        "Frontal: begins at age 2, pneumatizes up to age 12-20",
        "Sphenoid: begins age 3, complete by early teens",
        "##Why Sinuses Develop?",
        "Reduce skull weight (lighter cranium without compromising strength)",
        "Increase nasal mucosal surface area for humidification/conditioning",
        "Vocal resonance (debated - sinuses contribute minimally)",
        "Mucosal reserve and immune surveillance",
        "Insulation of brain from thermal extremes",
        "Shock absorption in facial trauma (crumple zones)",
        "##Clinical Anatomy",
        "Maxillary sinus roof: infraorbital nerve runs through it",
        "Dental roots of 1st and 2nd molars may project into sinus floor",
        "Frontal sinus drainage disrupted by agger nasi cells (anterior ethmoid variant)",
        "Onodi cell: posterior ethmoid adjacent to optic nerve - surgical hazard",
        "Haller cell: infra-orbital ethmoid cell - narrows maxillary infundibulum",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 12 — PNS PHYSIOLOGY: FUNCTIONS
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Physiology of Paranasal Sinuses",
    bullets=[
        "##Mucociliary Drainage from Sinuses",
        "Sinus mucosa lined with ciliated pseudostratified columnar epithelium",
        "Ciliary beat directed toward natural ostium (NOT toward dependent wall)",
        "Mucus transported in a spiral pattern to the ostium, regardless of head position",
        "Maxillary sinus: mucus ascends to superior ostium against gravity",
        "Blocked ostium = stasis = secondary infection = CRS",
        "##Sinus Ventilation & Pressure",
        "Normal sinuses are aerated - air freely exchanges with nasal cavity",
        "Sinus mucosa reabsorbs O2 slightly faster than it is replaced (slight negative pressure)",
        "Obstruction → negative pressure → barotrauma → mucosal edema (vicious cycle)",
        "Aerosinusitis: pain during aircraft descent (rapid pressure changes)",
        "##Nitric Oxide Production",
        "Paranasal sinuses produce the highest nasal NO concentrations",
        "NO diffuses into nasal airstream during breathing",
        "Functions: microbicidal, ciliostimulatory, vasodilatory",
        "Nasal NO measurement: screening tool for PCD (<77 ppb = abnormal)",
        "##Immune Functions",
        "Sinus mucosa: IgA secretion, mucosal mast cells, subepithelial lymphocytes",
        "Sinuses warm and humidify air reaching the lower respiratory tract",
        "##Nasal NO Values",
        "Normal nasal NO: 77-2000 ppb",
        "PCD: < 77 ppb (very low - defect in mucociliary-dependent clearance)",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 13 — CRS & MUCOCILIARY DYSFUNCTION (Clinical Correlate)
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Clinical Correlates: Chronic Rhinosinusitis (CRS)",
    bullets=[
        "##Pathophysiology",
        "Trigger: viral URTI → mucosal edema → OMC obstruction → stasis",
        "Reduced pO2 in sinuses → impairs ciliary function further",
        "Bacterial colonization: Strep. pneumoniae, H. influenzae, S. aureus",
        "Chronic inflammation → mucosal thickening → polyp formation",
        "##Mucociliary Component",
        "CRS patients: reduced ciliary beat frequency",
        "Mucus composition altered: thicker, more viscous (CF-like picture in severe CRS)",
        "Delayed saccharin clearance test",
        "Secondary PCD-like appearance on electron microscopy (reversible with treatment)",
        "##Nasal Polyps",
        "Type 2 eosinophilic inflammation dominates in CRS with nasal polyps (CRSwNP)",
        "IL-5, IL-13, eotaxin-driven eosinophilia",
        "Superantigen hypothesis: S. aureus enterotoxins stimulate massive IgE response",
        "##Treatment Rationale Based on Physiology",
        "Topical nasal steroids: reduce mucosal edema → open OMC → restore drainage",
        "Nasal saline irrigation: directly improves mucociliary clearance",
        "FESS: surgically widens OMC → restores aeration and drainage",
        "Biologics (dupilumab, mepolizumab): target IL-4R/IL-13/IL-5 in refractory CRSwNP",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 14 — NASAL VALVE & SEPTAL DEVIATION (Clinical Correlate)
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "Clinical Correlates: Nasal Valve, Septal Deviation & Turbinate Hypertrophy",
    bullets=[
        "##Turbinate Hypertrophy",
        "Mucosal type: bilateral, responsive to decongestants (allergic / vasomotor rhinitis)",
        "Bony type: unilateral, unresponsive to decongestants - compensatory hypertrophy",
        "Compensatory hypertrophy: turbinate enlarges to fill space opened by septal deviation",
        "Correcting septum without turbinate: obstruction persists on contralateral side",
        "Treatment: antihistamines, topical steroids; turbinoplasty if unresponsive",
        "##Internal Nasal Valve",
        "Most common site of fixed nasal obstruction",
        "Area < 0.4 cm2 = significant obstruction",
        "Spreader grafts: widen the internal valve angle (open rhinoplasty approach)",
        "##External Nasal Valve",
        "Collapsible alar cartilage (LLC) - dynamic collapse on inspiration",
        "Treated with: lateral crural strut grafts, alar batten grafts",
        "##Paradoxical Nasal Obstruction (recap)",
        "Deviated septum → fixed obstruction on deviated side",
        "Nasal cycle turgescence on open side → perceived as obstruction on normal side",
        "Patient complains of obstruction contralateral to anatomic deviation",
        "##Objective Measurement",
        "Acoustic rhinometry: maps cross-sectional area at nasal valve + turbinate level",
        "Rhinomanometry: measures resistance before and after decongestion",
        "Normal combined resistance: < 3 cm H2O/L/s",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 15 — SUMMARY TABLE
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
# Background + header
add_rect(slide, 0, 0, 13.333, 7.5, LIGHT_GRAY)
add_rect(slide, 0, 0, 13.333, 1.1, NAVY)
add_rect(slide, 0, 1.1, 13.333, 0.06, TEAL)
add_text(slide, "Summary: Functions of the Nose & Paranasal Sinuses",
         0.3, 0.08, 12.5, 0.95, font_size=26, bold=True, color=WHITE,
         align=PP_ALIGN.LEFT, anchor=MSO_ANCHOR.MIDDLE)

# Table data
rows = [
    ("Function",           "Structure",                  "Mechanism",                        "Clinical Relevance"),
    ("Airflow",            "Nasal valve + turbinates",   "Ohm's law; 10-15° valve angle",    "Septal deviation, turbinate Hx"),
    ("Warming",            "Turbinate blood vessels",    "Countercurrent heat exchange",     "Atrophic rhinitis, ENL"),
    ("Humidification",     "Nasal glands + mucosa",      "~1 L/day fluid produced",          "Dry environments, smokers"),
    ("Filtration",         "Vibrissae + mucus blanket",  "Impaction of particles in mucus",  "Mucociliary dysfunction, PCD"),
    ("Mucociliary",        "Ciliated epithelium",        "9+2 axoneme, 7-16 Hz beat",        "CRS, PCD, cystic fibrosis"),
    ("Olfaction",          "Olfactory epithelium",       "G-protein coupled ORN / cAMP",     "Post-viral, PD, head trauma"),
    ("Immunity",           "NALT, IgA, mast cells",      "Innate + adaptive first-line",     "Allergic rhinitis, CRS"),
    ("NO production",      "Paranasal sinuses",          "High conc; microbicidal",          "Low NO in PCD (diagnostic)"),
    ("Sinus drainage",     "OMC + ciliated mucosa",      "Spiral mucociliary to ostium",     "CRS, OMC blockage, FESS"),
    ("Vocal resonance",    "Sinuses (minor role)",       "Air-filled resonance cavities",    "Sinonasal voice change"),
    ("Skull lightening",   "Pneumatized sinuses",        "Replace bone with air",            "Sinus aplasia variants"),
]

# Table dimensions
col_widths = [2.2, 2.8, 3.8, 3.8]
col_xs = [0.15, 2.35, 5.15, 8.95]
row_h = 0.44
start_y = 1.2

for ri, row in enumerate(rows):
    for ci, cell in enumerate(row):
        is_header = (ri == 0)
        bg = NAVY if is_header else (LIGHT_TEAL if ri % 2 == 0 else WHITE)
        fc = WHITE if is_header else DARK_GRAY
        add_rect(slide, col_xs[ci], start_y + ri * row_h,
                 col_widths[ci] - 0.05, row_h - 0.02, bg)
        add_text(slide, cell,
                 col_xs[ci] + 0.05, start_y + ri * row_h + 0.02,
                 col_widths[ci] - 0.1, row_h - 0.04,
                 font_size=10.5 if not is_header else 11.5,
                 bold=is_header, color=fc,
                 align=PP_ALIGN.LEFT, wrap=True,
                 anchor=MSO_ANCHOR.MIDDLE)

add_rect(slide, 0, 7.25, 13.333, 0.25, NAVY)
add_text(slide, "Physiology of Nose & PNS  |  Postgraduate ENT", 0.2, 7.26, 10, 0.22,
         font_size=9, color=RGBColor(0xBB, 0xCC, 0xDD), align=PP_ALIGN.LEFT)


# ════════════════════════════════════════════════════════════════════════════
# SLIDE 16 — EXAM TIPS & KEY POINTS
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "High-Yield Exam Points",
    header_color=RGBColor(0x1E, 0x5C, 0x3A),  # dark green
    accent=RGBColor(0x2E, 0xA8, 0x5A),
    bullets=[
        "##Nasal Valve",
        "Nasal valve angle = 10-15° between ULC and septum - NARROWEST part of airway",
        "Resistance is inversely exponential to lumen area",
        "##Nasal Cycle",
        "80% of population; period ~2.5 hours; total resistance constant",
        "Paradoxical nasal obstruction: obstruction felt on OPEN side",
        "##Mucociliary",
        "Ciliary ultrastructure: 9+2 axoneme; propulsive stroke in gel layer; recovery in sol layer",
        "Beat frequency 7-16 Hz; stops below 10°C, above 45°C",
        "PCD: absent dynein arms; Kartagener = PCD + situs inversus + bronchiectasis",
        "Nasal NO < 77 ppb = diagnostic for PCD",
        "##Olfaction",
        "Only special sense bypassing thalamus (direct to piriform cortex)",
        "Basal cells regenerate ORNs - unique capacity for neuronal regeneration",
        "Post-viral anosmia: sustentacular cell damage (COVID-19 mechanism)",
        "##PNS",
        "Sinus mucus transported to natural ostium, not dependent wall (against gravity in maxillary)",
        "OMC blockage = central pathology in CRS",
        "Sphenoid sinus surrounded by optic nerve, ICA, pituitary, cavernous sinus",
        "Onodi cell: posterior ethmoid adjacent to optic nerve - surgical danger zone",
    ])

# ════════════════════════════════════════════════════════════════════════════
# SLIDE 17 — REFERENCES
# ════════════════════════════════════════════════════════════════════════════
slide = prs.slides.add_slide(blank)
add_bullet_slide(slide, "References",
    header_color=RGBColor(0x3A, 0x3A, 0x3A),
    bullets=[
        "Flint PW et al. Cummings Otolaryngology: Head and Neck Surgery, 7th Ed. Elsevier, 2021",
        "-- Chapter on Nasal Physiology: Resistance, Airflow, Nasal Cycle (pp. 568-573)",
        "Scott-Brown's Otorhinolaryngology Head & Neck Surgery - Vol 1. CRC Press, 2018",
        "-- Chapter: Nose, Mucociliary Clearance, Ciliary Ultrastructure, Smoking Effects",
        "Ganong WR. Review of Medical Physiology, 26th Ed. McGraw-Hill, 2019",
        "-- Chapter: Olfaction, Nasal Reflexes",
        "Neuroscience: Exploring the Brain, 5th Ed. Bear, Connors, Paradiso. Wolters Kluwer, 2020",
        "-- Chapter 8: Olfactory Receptor Neurons, Signal Transduction",
        "Junqueira's Basic Histology, 17th Ed. McGraw-Hill, 2021",
        "-- Olfactory Epithelium, Respiratory Epithelium",
        "Fishman's Pulmonary Diseases and Disorders, 5th Ed. McGraw-Hill",
        "-- Nasopharyngeal Airways, Mucociliary Clearance",
        "Harrison's Principles of Internal Medicine, 22nd Ed. McGraw-Hill, 2025",
        "-- Disorders of Olfaction",
        "Fokkens WJ et al. EPOS 2020: European Position Paper on Rhinosinusitis. Rhinology 2020;58(S29)",
    ])

# ── Save ─────────────────────────────────────────────────────────────────────
out_path = "/tmp/workspace/nose-pns-ppt/Physiology_Nose_PNS_Postgraduate.pptx"
buf = BytesIO()
prs.save(buf)
with open(out_path, "wb") as f:
    f.write(buf.getvalue())
print(f"Saved: {out_path}")
print(f"Slides: {len(prs.slides)}")